EBOLA 2014-2015 FACTS & FIGURES - Läkare Utan Gränser · EBOLA 2014-2015 FACTS & FIGURES Key...

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EBOLA 2014-2015 FACTS & FIGURESKey financial data on MSF’s response tothe Ebola epidemic in West Africa

INTRODUCTION

Project expenses

Purchase of medi

Total expenses by on Ebola crisis Mar 2014 - Dec 2015

cal items

Purchase of non-medical items

Purchase of lands and facilities

Subcontracted services

Transport

Staff costs

Miscellaneous other operating costs

Total € by account family

103,962,525 €

General and Running Costs

1,099,68015,379,593

19,848,755271,199

4,445,80018,652,808

31,170,17955,546

13,038,965

The severity of the West Africa Ebola epidemic saw MSF launch one of the largest emergency operations in its 44-year history.

Between March 2014 and December 2015, MSF re-sponded in the three most affected countries - Guinea, Sierra Leone and Liberia – and also to the spread of cases to Nigeria, Senegal and Mali. At the peak of the epidemic, MSF employed nearly 4,000 national staff and more than 325 international staff who ran Ebola management centres as well as conducted surveil-lance, contact tracing, health promotion and provided psychological support. MSF admitted 10,310 patients to its Ebola management centres of which 5,201 were confirmed Ebola cases, representing one-third of all

WHO-confirmed cases. In total, the organisation spent nearly 104 million euros tackling the epidemic between March 2014 and December 2015. During the first five months of the epidemic, MSF handled more than 85% of all hospitalised cases in the affected countries.

Today MSF continues to support Guinea, Liberia and Sierra Leone by running Ebola survivor clinics that pro-vide a comprehensive care package, including medical and psychosocial care and activities to counter stigma.

Through this short report, MSF would like to provide transparency about its expenditure linked to the worst Ebola outbreak in history.

© Anna Surinyach

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2014-2015 FACTS & FIGURES

CONFIRMED CASES*

MSF EXPENSES (IN MILLIONS OF €)CONFIRMED CASES TREATED BY MSF

HOW DID MSF RESPOND TOTHE EBOLA OUTBREAK?

SIERRALEONE

SENEGAL + MALI + NIGERIA

GUINEA

LIBERIA

1,570

23

36.12

32.80

34.57

0.82

1,939

3,3518,704

1,670

3,151

36

1/3 of all confirmed patients

during the outbreak

were treated by MSF

FIRST PHASEfrom March until August 2006

90%treat by MSF

*Excludes probable and suspected cases.Data source: WHO Ebola Sitrep 16th March 2016.

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The West Africa Ebola epidemic, 67 times the size of the largest previously recorded outbreak, required an unprecedented response. MSF was the first organisa-tion on the ground to care for patients. With the rapid increase in cases and the lack of other humanitarian actors with experience in Ebola, MSF came under ex-treme pressure. Because of the high risk associated with responding to Ebola, and because previous out-breaks had been quite small in comparison, very few humanitarian actors had the experience or capacity to respond. In August 2014, during the peak of the out-break, MSF increased its on-ground capacity more than fourfold. In the first five months of the interven-tion, MSF was the organisation which provided the largest bulk of beds for ebola patients, and through-out the whole outbreak MSF handled a third of all con-firmed cases.

In previous Ebola outbreaks, MSF had only ever needed to operate one, or exceptionally two, Ebola manage-ment centers (EMC) at a time. During this epidemic, the organization set up and managed 15 EMCs and transit centers in the three most-affected countries,

operating up to eight simultaneously.

The total cost of the intervention was indeed very high, yet had no action been taken, the outbreak would have arguably spiralled further out of control and been more costly to contain. It must be noted too that treating pa-tients is only part of the overall cost; other measures were crucial in fighting the outbreak, such as surveil-lance, tracing people in contact with Ebola patients, prevention activities, purchasing supplies, conducting trainings, deploying human resources, and transport-ing staff and supplies.

The first Ebola outbreak occurred in 1976. Since then, sporadic outbreaks have taken place in various plac-es around central and Western Africa. Between 1976 and 2013, 2361 cases were reported. If this pace was maintained, the number of years it would have taken to reach the number of confirmed cases in the West Af-rica outbreak (2014-2016) would have been 447 years, arriving at the year 2461. This hypothetical calculation illustrates the unprecedented scale of the last outbreak compared to previous ones.

IN TOTAL, MSF SPENT 104 MILLION EUROS ON THE EBOLA EPIDEMIC: WAS THIS MONEY WELL SPENT?

1976 1977 1979 19891990

1992 1994 1994 1995 19961997

2000200120022003

2004 2004 2007 2008 2011 20122013

20142016

603 1 34 7 0 52 1 315 100 725 17 1 264 187 1

28705

HISTORICAL OVERVIEW OF EBOLA OUTBREAKS

0

5000

10000

15000

20000

25000

30000

5353

2.361 cases(yearly average: 64 cases)

28.639 cases(yearly average: 14.320 cases)

1976 2013

2014 2016

447 years

2 years

Number years it would have taken to reach number of confirmed cases in West Africa (2014-2016) if pace maintained

2461 yearsExpected year to reach 28.639 cases

Basically, we did in 2 years what would have been expected to happen in 447 years...

Number of cases

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To bring Ebola under control requires more than car-ing for patients. For example, outreach activities such as contact tracing, health promotion and disinfection of contaminated houses also represented a fundamental part of MSF’s activities, with teams working to detect and prevent the virus within the communities. Com-munity awareness-raising activities reached hundreds of thousands of people, including more than 500,000 people in one campaign in Monrovia alone. Another

example was MSF’s distribution of anti-malarial tab-lets to more than 650,000 people in Monrovia and 1.8 million people in Freetown. This was implemented with the dual aim of preventing malaria and reducing the pressure on Ebola management centres from people incorrectly assuming they had Ebola, as initial symp-toms are similar between the diseases. Thus the total number of beneficiaries is much larger than the 10,310 patients admitted to our Ebola management centres.

WHY IS THE NUMBER OF BENEFICIARIES SEEMINGLY SMALL COMPARED TO THE TOTAL COST?

WHAT WAS THE COST OF MSF’S INTERVENTION IN SENEGAL, MALI, AND NIGERIA?

THE SIX KEY ACTIVITIES TO BRING AN EBOLA OUTBREAK UNDER CONTROL

MSF spent nearly a million euros for the interventions in Senegal, Mali and Nigeria. In Nigeria and Senegal, MSF provided mainly technical support, whereas in Mali MSF took a more hands-on approach, due to Ma-li’s weaker health system and insufficient resources. When cases were confirmed in Mali, Nigeria and Sene-gal, swift action from national governments supported by MSF ensured that the disease was rapidly contained.

Speed is of the essence at the start of an outbreak and is not without high cost: the starting costs for Ebola outbreak control is usually around 500,000 euro. The positive experience of managing to contain the epidem-ic in these three countries highlights the importance of investing in strong surveillance and rapid response at the beginning of an outbreak to avoid a wider spread and high loss of life.

Non-Ebola healthcare: Ensure that medical care remains available for people with illnesses and conditions other than Ebola (malaria, chronic diseases, obstetric care, etc). This includes implementing stringent policies to protect health facilities and health workers, particularly in areas where they might come into contact with patients.

Awareness-raising: Conduct extensive awareness-raising activities to help communities understand the nature of the disease, how to protect them-

selves, and how to help stem its spread. This works best when efforts are made to under-

stand the culture and traditions of local communities.

Isolation and care for patients: Isolate patients in Ebola man-agement centres staffed by trained personnel and provide

supportive medical care and psychosocial support for patients and their families.

Safe burials: Provide and encour-age safe burial activities in the communities

Disease surveillance: Conduct and promote thorough disease surveillance in order to locate new cases, track likely pathways of trans-mission, and identify sites that require thorough disinfection

Contact-tracing: Conduct and promote thorough tracing of those who have been in contact with Ebola-infected people. If contacts are not mapped and followed

up, it undermines all the other activities and the disease will continue to spread.

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WHY WAS NEARLY A THIRD OF FUNDS SPENT ON STAFF COSTS?

WHY WAS MORE THAN 18 MILLION EURO SPENT ON TRANSPORT?

As the international response was initially slow in rec-ognising the severity of the outbreak and reacting, MSF had to use its own resources to fight the epi-demic alongside only a handful of other organisations in the first five months.

MSF employed nearly 4000 na-tional staff and over 325 interna-tional staff at the peak of the epidemic. Dur-ing 2013 (the year before the outbreak), MSF employed a total of 946 people in the affected countries. These figures show that MSF more than quadrupled its staff body in the affected countries, which naturally implied higher staff costs.

BEFORE THE OUT

BREA

Knational

international87967

AT THE PE

AK O

F TH

E OUTBREAK

national staff

4000international staff

325MSF STAFF ON THE FIELD

Even within MSF, an organisation with a higher toler-ance of risk than many other aid agencies, Ebola was considered especially hazardous. MSF therefore insist-ed on the most stringent safety protocols – for example limiting the time permitted in the high-risk zone, which

meant that staff were rotated every hour. The du-ration of frontline field assignments was also much shorter than usual – at the height of the outbreak, assignments

for international staff would last a maximum of six weeks. This was to ensure that staff remained

alert and did not become too ex-hausted. This high turnover and the focus on ensuring safety of its staff resulted in high financial

costs for the organisation.

43,560m3

8,294tonnes = 207

cargoplanes

A lot of the material had to be urgently imported by plane which resulted in high freight costs. In total, MSF flew in 8294 tonnes of material to the region with a volume of 43,560 cubic metres. This volume amounts to the equivalent of 207 full charter planes. A high turnover of qualified international staff also meant that transport costs increased.

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Huge investment was required in terms of medical con-sumable materials such as personal protective equip-ment (suits, goggles, gloves, rubber boots, masks, etc). Due to the need of medical staff to frequently change outfits to avoid contamination, more than 300 protec-tive suits were required each day for a facility that cared for 100 patients. Much of the equipment had to be burnt after only having been worn once. In total MSF pur-chased 521,736 protective overalls.

MSF also had to purchase material such as basic raw material for construction or rehabilitation of the Ebola management centres, water and sanitation material and other logistical material. MSF constructed 15 Ebo-la management centres, including the largest one ever built – a 250 bed structure in Monrovia.

WHY WAS 20 MILLION SPENT ON NON-MEDICAL ITEMS?

MSF PURCHASED

521,736protective overalls

As there is no proven treatment for Ebola, the total costs for medical items were proportionally lower com-pared to other diseases where expensive drugs and equipment need to be purchased. Also, isolation and care for patients is only one of several key activities to

WHY WAS 15 MILLION SPENT ON MEDICAL ITEMS?

bring an Ebola outbreak under control. The main costs for medical items included purchase of medicine, vac-cines, medical and laboratory equipment and thera-peutic food.

© David Darg

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WHY DID MSF SPEND MONEY ON TRAINING OTHER ORGANISATIONS?

WHERE DID THE MONEY COME FROM?

Out of the total 103, 962, 525 euros spent on the intervention, 20,667, 598 euros came from public institutional funds, whereas the rest – 83,294, 927 euro, was raised through private donations.

80% 20%

Private funding83,294,927 €

Public institutional funding20,667,598 €

As one of the few organisations with expertise in Eb-ola, MSF decided to take the unusual step of training a large number of staff from other organisations, both in Europe and in the affected countries. MSF spent a total of 437,000 euros on trainings in Europe, of which a significant part of participants came from external or-ganisations such as Médecins du Monde, Action Contre la Faim and Save the Children to name a few. MSF also assisted WHO and Centers for Disease Control (CDC) in developing their own training modules.

Thousands more were trained in the affected countries, such as in Kailahun, Sierra Leone, where 700 commu-nity health workers were trained, while more than 400 were trained in Monrovia. © Olga Victorie/MSF

© Tommy Trenchard

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Treatment Centers Training facility

Clinical trials

Survivor Clinic

Transit Units

Mobiele interventie


Clinical trials

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Mobiele interventieTreatment Centers Training facility

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MSF Ebola projectsMarch 2014 - December 2015Liberia, Sierra Leone & Guinea

CONAKRY • • FORÉCARIAH

MAGBURAKA •FREETOWN •

MONROVIA •

KAILAHUN •

• FARANAH

• KAMBIA

• BO

• FOYA

• BOMI • QUEWEIN

• GRAND CAPE MOUNT

• TÉLIMÉLÉ

• KISSIDOUGOU

• RIVER CESS

• KÉROUANÉ

• DABOLA

• BOFFA

• GUÉCKÉDOU• MACENTA

• KANKAN

GUINEA

SIERRALEONE

LIBERIA

Ebola management centre

LEGENDActivities set up and run by MSF

Transit centre

Training facility

Clinical trial site

Rapid response team

Survivors clinic

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EBOLA 2014-2015 FACTS & FIGURES - Läkare Utan Gränser · EBOLA 2014-2015 FACTS & FIGURES Key...

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